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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME <br /> -jet`-, ;ry 4 P\t11C� v-L--A (_;1 -y` �� Z ngStatus;CUP; <br /> OWNER ADDRESS (Number,Street,City,State,Zip) eed Restriction;CSM <br /> D '.)`) ■ S1 c■Y k )-2. 0(.0 , �V„) 01 c." , \\\ `>"lt Variance(# ) <br /> HOME PHONE CELL PHONE E-MAILADDRESS <br /> (q(--‘ 2-6`5—1,f`D�•S ICU(S S L L --C)-,\ (\ \( ' V,1`! ‘;‘'r 1∎4,-%.( <.:r') S. Plan drawn to scale <br /> AGENT INFORMATION ,CONTRACTOR INFORMATION nd includes dimensions <br /> AGENT NAME CONTRACTOR NAME <br /> 0 ite an including location <br /> AGENT ADDRESS CONTRACTOR ADDRESS ell/ tic <br /> (City,State,Zip) (City,State,Zip) etbacks <br /> PHONE PHONE ❑Slt n <br /> a township.proval from <br /> E-MAIL ADDRESS E-MAIL ADDRESS <br /> raDalplans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) <br /> EBZETLR PARCEL NUMBER: CURRENTZONINGs9 S ACREAGE vation of property <br /> ❑ �J t'l 'Z 31.6_y� <br /> f\ \ :N 2 L. frontage drawn to scale. <br /> OWNSHIP: SECTION: t, <br /> c. 1/4: , , + ❑Drive rmits <br /> ADDRESS: ( ,c nty,town) <br /> 5>,i-) 1 �i C\, 1���l C\A `-)�•\11 1-- 1 C\\v \ -,\\\ ")-`)b)�.i L ❑Sanita permits <br /> CSM: LOT SUBDIVISION BLOCK/LOT N <br /> ( ‘\c. F\c S l c; 1 l ', <br /> (public • �vate) �� <br /> PROPOSED PROJECT INFORMATION S AF REVIEW <br /> PROJECT DESCRIPTION: <br /> c e_k. V\tV,\ "--_-)C�.-< C i•N •\---',,\ ` ) oniing District <br /> . ❑This project is a new building or structure. LPef pitted Use? <br /> OThis project is an addition/alteration to an existing building or structure. <br /> SANITARY SERVICE: _,j PERMIT NUMBER: ral '•. <br /> EWER j �EPTIC (new -xisting <br /> HEIGHT IN FEET NUMBER OF STORIES: (Not induding basement) <br /> C I.0 CI Wei. •/Flo.• • ain/ <br /> `J Shorela •ttachment) <br /> AREA TO NEAREST SQUARE FOOT: <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches) ❑ Erosion I on of permit <br /> BASEMENT 1ST FLOG <br /> 4 TOTAL SQUARE FOOTAGE: 4, (Slopes, .• • 'ance, <br /> 2ND FLOOR: 3RD FLOOR: 11 J full - S) <br /> G ❑ Review L ' n Survey <br /> ESTIMATED CONSTRUCTION COST: and av • le O • ns. 6 <br /> (Please round to nearest dollar) -0. •♦ ♦ -0. -4. ,L=`, �` <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? Yes [ o ❑Don't know <br /> ❑ <br /> 2. Is there a wetland or floodplain on or near the property? Yes alo ['Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? Ffres U II o <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? [Yes jaio <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) - <br /> 6. Is a location survey required? (see reverse) Yes Ow 17zIDon't know <br /> 7. Is this to correct a violation? Dies / lo <br /> APPLICATION MUST BE SIGNED <br /> (Continue on Back) -► -► - <br /> 545-112(4/08) <br />